Effects of Legislation on Sports-Related Concussion.

Following the lead of Washington state and passage of the Lystedt Law in 2009, all states now have sports concussion laws designed to help protect youth athletes. This article examines the 3 basic tenets of youth sports concussion laws, challenges in implementation of state laws, and the first measures of success. Some of the major differences among state laws are also discussed.

Evaluation and treatment of the concussed athlete - update.

Athletes with sports related concussions are increasingly seeking medical care for management and guidance for return to play. This article aims to provide an updated review of the management of youth sports concussions including preseason planning, on the field identification of concussion, clinical management of acute concussion, and discussion of prolonged symptoms including headache.

The million dollar question: When should an athlete retire after concussion?

Management of acute concussions is guided by consensus statement, and the return-to-play process begins when an athlete's symptoms and examination return to baseline. This process may be relatively clear if symptoms resolve within the normal time frame following a first or second concussion. This decision-making process is more complicated in an athlete with prolonged unresolved symptoms, multiple concussions both with and without prolonged recovery, or a structural brain injury. In these situations, determining when to retire an athlete after concussion is a complex decision, without available evidence-based guidelines. This article will discuss absolute and relative contraindications to returning an athlete to contact sport following a concussion in three separate scenarios: following potentially life-threatening brain injury, persistent clinical symptoms or signs of prolonged postconcussion syndrome, and multiple concussions but without residual symptoms or signs.

Counseling athletes on the risk of chronic traumatic encephalopathy.

CONTEXT: Chronic traumatic encephalopathy (CTE) is a rare progressive neurologic disorder that can manifest as a combination of cognitive, mood and behavioral, and neurologic symptoms. Despite clinically apparent symptoms, there is no imaging or other diagnostic test that can confirm diagnosis in living subjects. Diagnosis can only be confirmed postmortem by specific histopathologic features within the brain tissue identified on autopsy. CTE represents a unique tauopathy that is distinct from other neurodegenerative diseases. EVIDENCE ACQUISITION: PubMed was searched from 1990 to 2013 for sport concussion and chronic traumatic encephalopathy. Articles were also identified from bibliographies of recent reviews and consensus statements. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: Although CTE is postulated to occur as a result of repetitive mild traumatic brain injury, the specific etiology and risk factors have not yet been elucidated, and postmortem diagnosis makes causality difficult to determine. CONCLUSION: When counseling athletes and families about the potential association of recurrent concussions and the development of CTE, discussion of proper management of concussion is cornerstone. Unfortunately, to date, there is no equipment that can prevent concussions; however, rule changes and legislation may decrease the risk. It is imperative that return to play is medically supervised by a provider trained in the management of concussion and begins only once symptoms have resolved. In addition, athletes with permanent symptoms should be retired from contact sport.

Exercise in the older adult: from the sedentary elderly to the masters athlete.

The diverse exercise goals of the aging population present several challenges to physicians. Whereas some Masters athletes aim to set personal time records, sedentary elderly persons may look to exercise to help maintain independence and combat functional decline. This review article examines the common cardiovascular and neuromuscular physiological changes associated with aging and how regular exercise is used to improve physiological parameters and functional abilities. Exercise precautions specific to the elderly population are discussed. Exercise recommendations for persons with osteoarthritis and after joint arthroplasty also are presented.

Radiating upper limb pain in the contact sport athlete: an update on transient quadriparesis and stingers.

Participation in contact sports exposes the athlete to a risk of cervical spine injury. Temporary neurological injuries manifesting as radiating arm pain or paresthesias, such as transient quadriparesis and stingers, present unique challenges for the sports medicine physician and will be reviewed in detail. The initial management of these conditions must recognize signs and symptoms of spinal cord injury and prevent further neurological sequelae. Evaluation will often include advanced imaging of the cervical spine in addition to serial neurological examinations. This review concludes with rational return-to-play guidelines for contact sport athletes.

Radiologic evaluation of the neck: a review of radiography, ultrasonography, computed tomography, magnetic resonance imaging, and other imaging modalities for neck pain.

The patient with neck pain may pose a diagnostic dilemma for the treating physician. As with other areas of medicine, imaging is guided by the history and physical examination. The steady advance of 3-dimensional, functional, and nuclear medicine studies make it increasingly important that the ordering physician be aware of the potential benefits and disadvantages of imaging options. This article reviews the current literature on imaging for the patient with neck pain, illustrates several imaging abnormalities, and discusses the workup of commonly seen patient populations.